13
DISCUSSION SIPE is a well known entity that affects limited members of the community. It typically is found in those that spend time in cold water exercise such as military training with heavy swimming and surface swimming. It tends to occur with prolonged fin use and overhydration prior to the activity. It is theorized that a weakness or failure in the pulmonary capillaries is the cause of the pulmonary edema. - - Overhydration prior to the exercise increases the load on the capillaries and can weaken the blood-gas barrier causing them to leak into the lungs. The cold temperature of the water contributes by vasoconstricting the peripheral vessels and increasing core blood volume. This also increases pulmonary pressures as well as preload and afterload. Stress furthers this effect with vasoconstriction due to sympathetic activity. - - The net effect is increased volume and pressures in the lungs that can leak RBCs and protein-containing edematous fluid into the interstitium. The resulting pulmonary edema can cause dyspnea, tachypnea, cough and reduced oxygen saturation. - - References: Ludwig BB, Mahon RT, Schwartzman EL. Cardiopulmonary function after recovery from swimming-induced pulmonary edema. Clin J Sport Med. 2006; 16: Lund KL, Mahon RT, Tanen DA, et al. Swimming-induced pulmonary edema. Ann Emerg Med. 2003; 41: Adir Y, Shupak A, Gil A, et al. Swimming-induced pulmonary edema: clinical presentation and serial lung function. Chest. 2004; 126: Yoder JA, Viera AJ. Management of swimming-induced pulmonary edema. Am Fam Physician. 2004; 69: